1516 (2) NO.
EE
ON FOR PLUMBING PERMIT
1 APR 261Z CITY OF CUPERTINO
cFrY195- Permit No. ��L Z�
l�1 't1"
\ Fee
Ap lication is hereby made to the City of Cupertino for a permit to install plumb ng
j. cy pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i O and/or fixtures in accordance with the provisions of the Plumbing Code of,the City of
Cupertino, and all other laws applicable thereto.
Use of Premises /y+7. J;lrMiv
�F '"• Own �• r• V� �� Addressz�yDe ApPz� /&W,
;`.
Rr-rlice• e Address 5,4 fC wsvu -cvt-r
t /� PyIAC'rOR, AGENT -
.j Phone 967- 349/ Approved �,,
,5`y PLUMBING INSPECTOR .
SMT-OkES -NUNIBER MAIN DR IN.'
,UNITS I FEES II UNITS FEES
Water Heater Size I �'
Water Closets _ _ Material
Bath TubsTo-Curb -�"`'• i
I I 11
Showers _ To Prop. Line .' l
Lavatories , To Existing
Kitchen Sinks Not Conn. 1
Dish Washers I liq FW R BOXE2 I'
_Waste Disposals 1 II I' f
Wash Trays STORM DRAINAGE }s
Washing Machines Size
Water Softeners I I I Material -
Bar Sinks 'I 11 To Main Drain (,
Comb. Sink a Traysj To Curb'
, Dental Units
Di-inking.Fountainsl
Floor Drains WA'-
Hoppers Size
Restaurant Sinks 1 Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain I'm IVTjj
Water Leaders Storm Drain Fee,
Sprinkler'Valves I I Water Sys. Fee— .
f/aP f RFd� Permit Fee
TOTAL NOTAL FEE Y
RE,CPW OF P ON ? of
Partial Rough L
Rough Complete?
Final M.